Participant GuideJune 18, 2007
Medicaid Eligibility Specialist
Orientation & Training Guide
Table of Contents
Orientation & Training Guide
Page 3Introduction to Orientation and Training
Page 5Orientation and Training Activities
Resource Section
Page13Common Acronyms
Page14Classes of Assistance
Page 15Clearinghouse Fact Sheet
Page 16Your Responsibility in Reporting Child Abuse or Neglect
Page 17CPS Referral Situations
Page 18Classroom Standards, Expectations and Attendance Policy
Page 21Training Information
Introduction to Orientation & Training
We are excited that you have decided to join the team of Medicaid Eligibility Specialists (MES) at the Department of Family and Children Services (DFCS). You will be joining a team of professionals that are dedicated to helping Georgia families achieve healthy, independent and self-sufficient lives.
This booklet is your guide to orientation and training and is important to your job as aMedicaid Eligibility Specialist. The purpose of this orientation is to give you, the new worker, a minimum of five days to become familiar with some of the basic information about the Division of Family and Child Services. You will become aware of the different programs within DFCS, the various partner agencies which are closely connected to DFCS, and the manuals you will be using both during the training program as well as when you return to your county assigned position.
This Orientation Guide contains a list of daily activities you are expected to complete and a resource section with materials that you are expected to read prior to attending classroom training. The activities are organized in checklist format. This checklist must be brought to classroom training to verify your completion of all activities.
Your supervisor may assign one or more of your co-workers to give you guidance with the completion of the orientation activities. You may not be able to complete each activity on its scheduled date due to logistics and availability. Your supervisor or training coordinator will coordinate these changes for you. If you experience any problems or have questions, discuss them with your supervisor. Your co-workers can also act as your helper but only utilize them in this capacity if you have been instructed to do so by your supervisor.
Your training begins now!
It consists of the following:
In-county orientation to give you a basic understanding of DFCS and your new role as a Medicaid Eligibility Specialist (MES).
Phase I Training - 17 days of training in ABD Medicaid policy.
Phase II Training - 8 days of training in ABD Medicaid SUCCESS procedures.
On-the-Job Training in your county office. Your supervisor will receive a checklist of additional topics on which you will need training in your county.
Phase III Training - 5 days of training in specialized topics for ABD Medicaid.
Certain materials should be brought to classroom training. These materials include the following:
- Orientation & Training Checklist – requires your supervisor’s signature.
- Resource Referral Information document for your county and region.
Orientation
& Training
Activities
ACTIVITIES TO BE COMPLETED DURING
ORIENTATION
Instructions: Below is a list of activities that a new Medicaid Eligibility Specialist will need to complete prior to attending classroom training. As you complete each activity, please have your supervisor, training coordinator or mentor initial in the box marked “Sign-Off Here”. Once each activity is complete,you will be ready to receive the final portion of training.
Activities to be completed prior to beginning classroom training:Sign – Off Here / Day One Activities
Complete all basic personnel paperwork such as payroll deductions and flexible benefits.
Tour the facility and note the organization of the county office (mail room, break room, restrooms, copier, and forms room).
Introduce yourself to your fellow Medicaid Eligibility Specialists, the Supervisors, the Program Managers, the CountyDirector and the Medicaid Field Program Specialist.
Meet your assigned Mentor or Training Coordinator.
Review Supervisor’s expectations regarding general office operations.
Work hours / FLSA Time Sheets
Annual / Sick Leave
Telephone Procedures
Sign in/out procedures
Complete Forms 291 and 297 to apply for a SUCCESS RACF ID.
Complete requests for Novell and GroupWise IDs and passwords.
Review with your supervisor your Performance Management Plan (PMP) and keep copy.
View the “Title VI”, and HIPAA video.
Discuss the Orientation and Training Packet with your supervisor.
Discuss training: location, length and expectations.
Using the ETS web site ( obtain an internet ID and password.
Complete the Online Orientation using the IOTIS training which can be located at Enter your User ID and Password to access the Online Orientation.
Complete the ADA Online Module using the OITIS training which can be located at
Visit the DHR website at and review the following:
GeorgiaDepartment of Human Resources Fact Sheet
DHR Vision/Mission and DFCS Mission Statements/ Purpose/ Goals
Division of Family and Children Services Fact Sheet
The Family Independence Worker’s role in DFCS
Quality Control
TANF at a Glance
Office of Child Support Services
Subsidized Child Care in Georgia
EBT in Georgia
Food Stamp in Georgia
Medicaid for Aged, Blind or Disabled in Georgia
Medicaid for Pregnant Women and Children
Protecting Children, Improving the System
Adult Protective Services Fact Sheet
Foster Care in Georgia
Office of Adoptions
Domestic Violence in Georgia Fact Sheet
Refugee Resettlement
Division of Public Health Fact Sheet
Division of Aging Fact Sheet
Division of Mental Health, Developmental Disabilities, and Addictive Diseases Fact Sheet
Log on to ODIS at and review the procedure for locating Medicaid policy.
Have someone in the county show you how to access Georgia Online e-mail clearances. There is a Bulletin Board available that lists clearances that have been issued on the Medicaid helpdesk.
Sign – Off Here / Day Two Activities
Using Appendix E of the Medicaid Glossary on ODIS, complete the “Common Acronyms” found on Page 13 in the Resource Section.
Walk through the Medicaid Case Management process with a mentor and make note of each step of the Medicaid Case Management process.
Observe county procedures from the front desk view. As you observe, answer the following questions.
Where is applicant’s name recorded?
What form is used to record the applicant’s information?
Is the applicant interviewed on the same day or given an appointment?
How does the receptionist notify the case manager that the applicant is in the office?
How are “drop-ins” handled?
Observe the employee that screens and registers new TANF, Food Stamp, ABD, or Family Medicaid applicants in the SUCCESS system.
Spend time observing the waiting area. Look through and read the information on the walls of your county’s waiting room.
Review the forms for ABD Medicaid listed in the Online Policy Manual. Have your supervisor, training coordinator, or mentor identify frequently used forms. Obtain the forms that you will need at your desk when you return from training, if they are not already there.
Read the “Understanding Medicaid” pamphlet.
Read the brief explanation of Classes of Assistance found in the Resource Section on page 14.
Go with a co-worker to the courthouse and observe the procedure for completing a property search.
Go with a co-worker to a nursing home (NH) and observe her interactions with staff and patients. Meet the NH staff.
Sign – Off Here / Day Three and Four Activities
Identify or develop a resource booklet that outlines the in-house and partner resources available to your agency to serve ABD Medicaid customers. Obtain a list of names, phone numbers and addresses for resources of individuals, groups, organization, and agencies that are commonly used by your county.
Ask your mentor to discuss with you the various state and federal agencies that work with DFCS and the role that they play. Examples of these agencies are the Department of Medical Assistance, Social Security Administration, Centers for Medicare & Medicaid Services (CMS), and the related waiver agencies such as Hospice and Community Care Services Program (CCSP).
Observe as many of the following types of interviews as possible within days three and four, paying special attention to how the questions are posed to the customer and how the MES collects information:
- ABD Medicaid Public Law initial application
- FS/ABD Medicaid initial application
- Nursing Home ABD Medicaid initial application (mandatory)
- Medically Needy ABD Medicaid initial application (mandatory)
- Q Track ABD Medicaid initial application
- FS/ABD Medicaid review
- ABD Medicaid Public Law review
- Medical Treatment Facility review for ABD Medicaid
- Medically Needy ABD Medicaid review
- Q Track ABD Medicaid review
- Interview of a client who is a “walk-in” (mandatory)
Observe a veteran worker complete an ABD Medicaid application from interview to approval. (Mandatory) This process does not have to be on the same case, as long as the steps from start to finish are identified.
Organize bills for a Medically Needy case and call the providers to determine if the medical bills are still usable and that the bills have not been “written off”. Observe a worker completing this activity prior to attempting it on your own.
For one hour, answer the phone of a Medicaid caseload to better understand the ABD Medicaid problems and complaints that arise from clients. Consult with supervisor, training coordinator, or mentor to answer questions/issues that arise.
Sign – Off Here / Day Five Activities
Have an experienced MES demonstrate how to update Scheduling and how to manage the caseload by using the Alerts on SUCCESS.
Locate where SUCCESS reports are kept in your county. Review with supervisor the following SUCCESS reports and identify the report’s purpose:
- DMF8062I Weekly Application SOP Report
- DMF800TI List of Active Cases Due for Review
- DMF8051I Case Assignment Report
Review the SUCCESS screens found in Sections 3.1, 3.2, 3.3, 3.4, and 3.5 in the SUCCESS User Manual.
Review the Clearinghouse Fact Sheet in the Resource Section on Page 15 and have a co-worker show you how to access Clearinghouse when not doing an interview.
Read the SUCCESS remarks screens of several different types of cases for both applications and reviews.
Read the SUCCESS Documentation Standards.
Review an entire case on SUCCESS that is a good example of a correct case that has been well documented.
Review an ABD Medicaid application or alternate review.
Read “Your Responsibility in Reporting Child Abuse or Neglect” found in the Resource Section on page 16 and “CPS Referral Situations” on page 17. (Mandatory)
Review supervisor’s expectations regarding the following:
Travel reimbursements for training
Work hours and FLSA time sheets while away at training
Etiquette while at training and read:
- DFCS Classroom Standards, Expectations and Attendance Policy (See page 18.)
- DFCS Training Information (See page 21.)
Bring the following supplies and materials to training:
Writing Utensils (pens, pencils, highlighters)
Pads (Legal 81/2 X 11)
Post-It Notes
Tabs
Your newly developed Resource Booklet or Manual.
Orientation & Training Checklist
Collect needed forms including:
Travel Reimbursement
Time Sheets
Return Envelops
Make sure you have your GroupWise e-mail id and password, your supervisor’s name and phone number.
You are almost finished. See you in the Classroom!
Resource Section
Common Acronyms
ABD -
AMN -
A/R -
AU -
BAD -
BENDEX -
CMD-
COLA -
DCH -
FBR -
HIPP-
ICWP -
ICF -
ISM -
LOC -
MTF -
NH -
PL -
QMB -
RSDI -
SLMB -
SOP -
SMEU -
SSI -
TPR/TPL -
Classes of Assistance
During the eligibility determination process, the MES must consider for which type of Medicaid the applicant or recipient (A/R) may be eligible. Medicaid benefits may vary depending on the type of Medicaid. The benefits range from full Medicaid benefits, to time limited benefits, to partial payment of the Medicare premium. These different types of Medicaid are called “Classes of Assistance” (COA). COAs are roughly divided into two categories – Federal Benefit Rate (FBR) and Non-Federal Benefit Rate (Non-FBR).
All FBR COAs use the Supplemental Security Income (SSI) regulations to set the income and resource limit and adhere to the SSI guidelines to determine eligibility. These COAs consist of all the Public Law COAs and the SSI related Medicaid. Eight COAs fall into this category.
The Non-FBR COAs consist of everything else. The income and resource limits of these COAs vary depending on which one it is. These COAs are made up of the “Medical Treatment Facility” (Institutionalized) classes such as Hospital, nursing home, Hospice Care, etc.; the “Waivered” COAs such as Deeming Waiver, Mental Retardation Waiver, etc.; the “Q Track” COAs such as Qualified Medicare Beneficiaries, Specified Low-Income Medicare Beneficiaries, etc.; and Adult Medically Needy. Seventeen COAs fall into this category.
Each COA has its own set of regulations that the A/R must meet in order to qualify for ABD Medicaid. If an A/R does not meet the criteria for any COA, then that A/R cannot receive ABD Medicaid. However, it is possible that s/he may qualify for one of the Family Medicaid Classes of Assistance. COAs will be discussed in depth during the ABD Medicaid policy portion of training.
Clearinghouse Fact Sheet
County offices have on-line access to information from the Social Security Administration (SSA) and the Department of Labor (DOL). This information must be accessed for correct determinations of eligibility. Clearinghouse is on-line and current.
Clearinghouse contains the following files:
- DOL wages files - contain most recent five quarters of employment history
- DOL employer address files
- DOL UCS file - lists monthly benefits for the most recent 13 months and individual checks for last ten weeks
- DOL UCS claimant address file - lists address of each UCB recipient
- SSA BENDEX - contains RSDI benefit information
- State Data Exchange (SDX) - contains SSI benefit information
Data from DOL-UCB, SDX, and SSA BENDEX is considered verified. Income discovered should be budgeted. Data from DOL wage files is a lead and the case manager must contact at least the last employer to determine current employment status of A/R.
Policy requires that Clearinghouse be accessed in the following situations:
- Access all wage and UCB data for all persons in a case that are 16 or older prior to initial approval of an application and during the review process.
- Access same information before adding a person 16 or over to an existing case
- Access SDX for all AU members.
- Access BENDEX for all AU members.
- MAY access any individual who may affect eligibility. Examples include absent parents, parents/legal guardians of a minor caretaker, stepparents, sanctioned standard filing unit individuals, spouses of non-parent caretakers, ineligible aliens, persons disqualified for intentional program violations, and persons who presence or absence in the home is questionable. Accessing an individual who is not in the home or whose SSN is not in the SUCCESS database requires documentation of the reason for access and prior supervisory approval for access.
When accessing Clearinghouse, if data is available, a screen print of the file must be placed in the case record. If no data is available, the record can be documented with the case manager's initials and date of attempt OR a screen print showing "no data available" can be filed.
In order to access Clearinghouse, the case manager must have an individual RACF ID and password.
Your Responsibility in Reporting Child Abuse or Neglect
(ESS 3020)
ALL DFCS EMPLOYEES ARE REQUIRED BY LAW TO REPORT CHILD MALTREATMENT OR SUSPECTED ABUSE.
Even though your contact with a family may be limited to short office visits and telephone calls, you could observe or receive information that warrants a referral to child protective services.
ANY SUSPECTED ABUSE OR NEGLECT MUST BE REPORTED.
Your responsibility will be to report anything that you suspect is abuse. This includes but is not limited to the following:
observing physical signs (ex., bruises, black eye) on a child during an interview
observing abusive action during the interview
someone discloses information during the interview
someone discloses information during a telephone call
IF IN DOUBT, REPORT - ALWAYS ERR ON THE SIDE OF THE CHILD
CPS intake workers will screen all reports and determine whether to assign for investigation.
ALL REPORTS SHOULD BE MADE VIA TELEPHONE CALL AND FOLLOWED UP IN WRITING AS SOON AS POSSIBLE
If someone tells you of abuse during the interview or in a telephone call, connect them with the CPS intake unit at that time if possible. It is always best for the CPS worker to talk with the person who has the most knowledge. If you suspect the abuse, you need to call CPS. Always follow up in either situation with a Form 713 and route to CPS intake in your county. Keep a copy of the Form 713 for your record. If the child who is reported as being abused lives in another county, your CPS intake staff will follow up with notifying the correct county.
INCLUDE AS MUCH INFORMATION AS POSSIBLE IN THE REFERRAL
Child’s name, age and address (and current location, if different from address)
Parent’s name, address and telephone number
Reason for the referral (observation or information disclosed)
Reporter’s name, address, telephone number and relationship to the problem.
IF SOMEONE ELSE DISCLOSES THE INFORMATION THAT WARRANTS THE REFERRAL, THEY DO HAVE THE RIGHT TO REMAIN ANONYMOUS
CPS Referral Situations
Situation 1: Client comes in for a Food Stamp review and brings her two children with her. One is four and the other is six months old. Both get restless during the interview and begin crying. The client screams at the four-year-old to stop crying. You notice he screams and shrieks back in terror. You observe bruises on his cheeks and his arms. She picks up the baby and shakes her roughly also telling her to be quiet. You notice also that there are bruises on the baby’s legs.